乳腺癌术后局部复发的治疗及预后分析

The management and prognosis of postmastectomy local recurrence in 477 breast cancer patients

目的探讨乳腺癌术后局部复发的治疗方案及影响预后的相关因素。方法回顾性分析天津肿瘤医院2002年7月至2005年2月期间收治的477例乳腺癌术后复发患者的临床资料。结果477例复发病例中，术后1年内复发占26．2％（125／477），2年内复发占61．2％（292／477）。局部复发后远处转移率为65．0％（310／477），复发后5年总生存率48．4％。不同复发部位、临床分型、有无放射治疗、放射治疗范围、有无手术切除或切除活检的亚组之间局部控制率的差异有统计学意义（P〈0．05）。不同原发肿瘤分期、无病间期、临床分型以及治疗方式的亚组间远处转移率及5年总生存率的差异有统计学意义（P〈0．05），多因素分析显示治疗方案单一、原发肿瘤分期晚、三阴型乳腺癌是影响复发性乳腺癌预后的独立危险因素（P〈0．05）。结论多部位复发者和三阴型乳腺癌局部控制不佳，局部扩大野放射治疗结合手术治疗是改善局部控制率的必要模式。原发肿瘤分期晚、2年内复发、三阴型的乳腺癌复发后容易发生远处转移，对于复发性乳腺癌采取综合治疗方案可以提高患者的生存率。

Objective To explore an optimal treatment and to study the prognosis related factors of breast cancer patients with local recurrence after mastectomy. Methods From 2002.7 to 2005.2, 477 female patients with loco-regional recurrence of breast cancer treated in Tianjin Cancer Hospital were analyzed retrospectively. Results In 477 cases, recurrence within 1 year after mastectomy accounted for 26. 2%, recurrence within 2 years accounted for 61.2%. There were 310 cases with metastasis after local recurrence was diagnosed, accounting for 65.0%. 5-year total survival rate after recurrence is 48. 4%. Local control rates varied in subgroups with different recurrence site, clinical subtypes, radiotherapy fields, with or without radiotherapy, surgical resection or excisional biopsy （P 〈 0. 05 ）. There was a statistical difference in distant metastasis rate and 5-year survival rate among subgroups which had different clinical stage of primary tumor, disease-free interval, clinical subtypes or treatment methods （P 〈 0. 05 ）. Simplistic treatment option, late clinical stage of primary tumor and triple-negative breast cancer were the independent factors predicting poor prognosis for recurrent breast cancer （P 〈 0. 05 ）. Conclusions Multi-site recurrence and triple-negative breast cancer lead to a poor local control. Local expansion of radiotherapy combined with surgery improves the local control rate. Patients with late clinical stage of primary tumor, recurrence within 2 years, triple-negative breast cancer are likely to have distant metastasis when recurrence is diagnosed. Combined treatment program improves survival rate.